NC0081621_Other Agency Documents_20220513

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGIJATIC ODEQ/DWP
NCAC 15A 8G .0201 MAY 1 3 2022
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Facility Name: Muddy Creek Wastwater Treatment Plant
WORO,,,,,,,,.,
Permit ItIOORESVIliCAPadi LOFFICF
Facility Type: WW L3 Facility Grade: 11 LI SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Travis Mark Fowler
Email Address:
[e-mail]
Permittee Signature:
Full Name: Matthew Dwayne Isenhour
Email Address.
[e-mail]
Certificate Type• WW
Signature:
Full Name:
Certificate Grade: IV
Date: S (c (3-D2-7.._
Work Phone: [phone]
Certificate #:
Effective Date:
1002601
6-/q
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and
failing to do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
ackup ORC
Karen Renee Marie
Certificate Type: WW Certificate Grade: IV
Signature:
Full Name:
Work Phone: [phone]
Certificate #:
1002612
Effective Date:
"I certify that 1 agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
ackup ORC
Kevin Morgan Graves
Certificate Type: WW
Signature:
Certificate Grade: IV LJ
Work Phone: [phone]
Certificate #:
999374
�► Effective Date: 5'512aZZ..
"1 certify that I agree to '•7A esignation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do
so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Mail, fax or email ORIGINAL to: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 1 FAX: [phone] J [e-mail]
Mail or fax a COPY to:
Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 28115 i FAX: [phone] I PH: 704-663-1699
Revised 3/2019

Page 2
Facility Name: Muddy Creek Wastwater Treatment Plant Permit #:
Full Name:
ackul
Braden Joshua Cook
Certificate Type: WW
Signature:
Certificate Grade: IV El
NC0081621
Work Phone:
Certificate #:
[phone]
1002815
Effective Date:
"1 certijy that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
aGku
Full Name: Adam Neal Love
Certificate Type: WW LJ Certificate Grade: IV LJ
Signature:
Work Phone:
Certificate #:
[phone]
1009200
Effective Date: .-
"I certify that I agrecs`fo my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
pc up
Full Name: Jesse Lee Wingler
Certificate Type: WW Certificate Grade: IV
Signature:
Work Phone:
Certificate #:
[phone]
1004838
Effective Date: 9" ?Z
I certify that f agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Full Name: Oriss Wayne Cross
Certificate Type: WW Certificate Grade: IV
Signature:
Work Phone: [phone]
Certificate #: 1010733
Effective Date:
"I certify that 1 r.ree to my d'.nation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."

Page 2
Facility Name: Muddy Creek Wastwater Treatment Plant Permit #:
Full Name:
Nicholas James Merwin
Certificate Type: WW Certificate Grade: IV
Signature:
Full Name:
NC0081621
Work Phone:
Certificate #:
[phone]
1006823
Effective Date: 5.— 5- Z Z
"/ certify that / agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. / understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Jeremy Michael Godwin
Certificate Type: WW LJ Certificate Grade: II
Signature:
92oituH,,
Work Phone: [phone]
Certificate #:
1011288
Effective Date: 5-S'I`,
"/ certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Full Name: Devin Malik Roberts
Certificate Type: WW LJ Certificate Grade: II
Signature:
Work Phone:
Certificate #:
[phone]
1011312
Effective Date: 5 - S
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
It
Full Name: Hope Elizabeth Seger
Certificate Type: WW Certificate Grade:
Signature:
Work Phone: [phone]
Certificate #: 1010041
Effective Date: — 5 - 2 Z
"1 certify/that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."

Page 2
Facility Name: Muddy Creek Wastwater Treatment Plant Permit #:
Full Name:
Jason Matthew Buck
Certificate Type: WW
Signature:
Certificate Grade: II
NC0081621
Work Phone:
Certificate #:
[phone]
1010967
�l G Effective Date: S7s/d :+—
certify that / agree to my designation cis a Back-up Operator in Responsible Charge for the facility noted. / understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
ac'up,
Full Name: Christopher Scott Yost
Certificate Type: WW LJ Certificate Grade: lI
Signature:
Work Phone:
Certificate #:
[phone]
1002797
Effective Date: .- (o — 2-"2-
"I certify that / agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Full Name: Nathaniel Ryan Hargrove
Certificate Type: WW Certificate Grade: IV
Signature:
Full Name:
Work Phone:
Certificate #:
[phone]
1002601
#4,th.a, , ®- Effective Date: 6-6 -.Z zz..
"/ certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
acku
Certificate Type: Select
Signature:
Certificate Grade: Select ID
Work Phone:
Certificate #:
Effective Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."